Evaluation of Implant Impression Accuracy Using Different Trays and Techniques With a 3D Superimposition Method

PURPOSE

The purpose of this study was to evaluate the dimensional accuracy of implant impressions obtained using different tray types and techniques.

MATERIALS AND METHODS

A partially dentate maxillary Kennedy Class II model was created as a reference model through three-dimensional (3D) printing. Then, 4.3-mm diameter implant analogs were placed at the first premolar, first molar, and second molar regions. Five types of trays-metal and plastic stock trays and custom trays fabricated using liquid crystal display (LCD), fused deposition modeling (FDM), and urethane dimethacrylate (UDMA) resin-were used to create impressions. Open- and closed-tray techniques were also compared. In total, 150 impressions were obtained. The reference model and impressions were scanned using a laboratory scanner. The positional and angular deviations of implants with different tray types and techniques were evaluated using the superimposition method.

RESULTS

There was no statistically significant difference (P>0.05) between the impression accuracy with the different tray types and impression techniques. The angular deviations with plastic and UDMA trays were greater than those with metal, FDM, and LCD trays. Angular deviation at the second molar by using closed trays was greater than that using open plastic trays. The highest and lowest positional deviation were observed at the first molar implant with an open plastic tray impression (mean: 62.46 ± standard deviation: 28.54 μm) and a closed LCD tray impression (36.59 ± 29.93 μm). The greatest angular deviation was observed with an open FDM tray impression at the first premolar implant (0.067 ± 0.024°), and the lowest angular deviation was observed with a closed metal stock tray impression at the second molar implant (0.039 ± 0.025°). Statistical differences were detected using Mann-Whitney U tests for pair groups and the Kruskal- Wallis test for groups with more than three comparisons (P>0.05).

CONCLUSION

Plastic and metal stock trays or conventional and 3D-printed custom trays can be used to obtain implant impressions for maxillary partially edentulous arches with similar dimensional accuracy. The five tray types and two techniques may be safely used to obtain impressions of partially edentulous maxillary arches with three implants.

Numerical and experimental investigation of the deviation of microparticles inside the microchannel using the vortices caused by the ICEK phenomenon

One field of study in microfluidics is the control, trapping, and separation of microparticles suspended in fluid. Some of its applications are related to cell handling, virus detection, and so on. One of the new methods in this field is using ICEK phenomena and dielectrophoresis forces. In the present study, considering the ICEK phenomena, the microparticles inside the fluid are deviated in the desired ratio using a novel ICEK microchip. The deviation is such that after the microparticles reach the floating electrode, they are trapped in the ICEK flow vortex and deviated through a secondary channel that was placed crosswise and noncoplanar above the main channel. For simulation verification, an experimental test is done. The method used for making two noncoplanar channels and separating the particles in the desired ratio with a simple ICEK microchip is an innovation of the present study. Moreover, the adjustment of the percentage of separation of microparticles by adjusting the parameters of the applied voltage and fluid inlet velocity is one of the other innovations of the present experimental study. We observed that for input velocities of 150-1200 µm/s with applied voltages of 10-33 V, 100% of the particles can be directed toward the secondary-channel.

Postoperative deviation in Wassel types II and III radial polydactyly: a retrospective analysis of 73 thumbs

This study examined the relationship between osteochondral stability and postoperative deviation at the interphalangeal (IP) joint in Wassel types II and III radial polydactyly. Cases with cartilaginous fusion between the radial distal phalanx and the proximal phalanx were classified as type IIB, while the remaining cases were categorized as type IIA. In conventional surgery, the cartilage was routinely resected on the radial aspect of the proximal phalangeal head, while in the modified procedure, this was preserved to avoid postoperative radial deviation. Postoperatively, there was no significant difference between both procedures in type IIA thumbs regarding IP joint deviation, whereas in type IIB/III thumbs, IP joint deviation was significantly higher in the conventional group (mean 19° [SD 16°]) compared to the modified group (mean 0.8° [SD 4.9°]). Surgeons should exercise caution against excessive cartilage excision to preserve osteochondral stability during procedures, especially for type IIB and III radial polydactylies.Level of evidence: IV.

Accuracy of the Yakebot dental implant robotic system versus fully guided static computer-assisted implant surgery template in edentulous jaw implantation: A preliminary clinical study

AIMS

To compare the accuracy of the Yakebot dental implant robotic system with that of fully guided static computer-assisted implant surgery (CAIS) template in edentulous implantation.

MATERIALS AND METHODS

Thirteen patients with edentulous were recruited and divided into two groups: the Yake robotic system group (experimental) (n = 5) and the CAIS group (control) (n = 8). Postoperative cone-beam computed tomography (CBCT) was performed immediately, and the 3-dimensional positions of implants were obtained and compared with that in the preoperative design. The comparison showed platform, apical, depth, and angular deviations. A value of p < 0.05 was considered statistically significant.

RESULTS

A total of 84 implants (36 in the robotic group and 48 in the CAIS group) were placed. The mean deviation at the implant platform, apex, depth, and angle in the CAIS group was 1.37 ± 0.72 mm, 1.28 ± 0.68 mm, 0.88 ± 0.47 mm, and 3.47 ± 2.02°, respectively. However, the mean deviation at the implant platform, apex, depth, and angle in the robotic group was 0.65 ± 0.25 mm, 0.65 ± 0.22 mm, 0.49 ± 0.24 mm, and 1.43 ± 1.18°, respectively. Significant differences in the four types of deviation (p < 0.05) between the two groups were observed.

CONCLUSION

The accuracy of robotic system in edentulous implant placement was superior to that of the CAIS template, suggesting that robotic system is more accurate, safe, and flexible, can be considered a promising treatment in clinical practice.

Dimensional and spatial computed tomographic abnormalities of the rectum and prostate are only partly reversible after surgical repair of perineal hernia in dogs

Caudal protrusion of pelvic organs and dilatation and deviation of the rectum with perineal hernia (PH) have not previously been studied using CT, and it is not known how completely the changes normalize after PH repair. Objectives of this prospective experimental case series were to evaluate the dimensions and shape of the rectum and the volume, location, and other features (enhancement pattern, presence of cysts, and mineralizations) of the prostate of 66 dogs on CT before and 3 months after PH repair. The rectal cross-sectional areas were measured at intrapelvic and caudal locations, and the shape was categorized as straight, deviated, flexure, or caudal fold on dorsal images. According to paired samples t-tests, the caudal rectal dimensions were significantly larger (P < .001) than the intrapelvic dimensions both before and 3 months after PH repair, and according to linear mixed models, the intrapelvic dimensions increased significantly (P < .001) after repair. Before PH repair, the most common rectal shape was flexure (69.2%); after repair, the number of dogs having a straight rectum increased significantly (P < .001) according to the McNemar paired-samples proportion test. We were also able to show that rectal dimensions increased after PH repair despite straightening in most dogs. According to the linear mixed model, prostate ratio volume, and according to Wilcoxon signed ranks test, the number of prostates with intraprostatic cysts decreased significantly (both P < .001) after PH repair, but the proportion of prostates located in the caudal or perineal area did not. Small mineralizations remained in some dogs.

Effect of prefabricated immediate interim prosthesis design and insertion workflow on seating accuracy on implants placed via static computer-assisted implant surgery: A cross-sectional in vitro study

BACKGROUND

Immediate implant restoration by prefabricated prosthesis has multiple benefits. However, the design and insertion workflow of the prosthesis may influence the seating.

PURPOSE

Evaluation of seating accuracy of prefabricated interim prosthesis of different designs and insertion workflows for immediate restoration of implants placed via static computer-assisted implant surgery (sCAIS).

MATERIALS AND METHODS

A maxillary model without incisors was used to plan for two implants at the lateral incisor locations. According to the planned implants, sCAIS surgical template and a four-unit interim prosthesis were designed. Four prostheses were fabricated based on the design and insertion workflow. The first prosthesis involved complete fabrication (CF) of the interim prosthesis, where the interim prosthesis is fabricated for laboratory attachment to abutments. The other three prostheses were produced by partial fabrication (PF), where the interim prosthesis shell was produced with internal spacing between the fitting surface and the abutments. The PF prostheses were cemented on abutments attached to the inserted implants. Three different PF prosthesis designs were included with different levels of internal spacing: 100 μm (PF.1), 200 μm (PF.2), and 300 μm (PF.3). A total of 15 surgical models received implants on which each prosthesis was seated and scanned by a laboratory scanner. The vertical, horizontal, and proximal contact errors were measured.

RESULTS

Although all prostheses were seated on every model, the CF prostheses had greater vertical error, followed by PF.1, PF.2, and PF.3 prostheses, respectively. A similar pattern was observed for proximal contact error, where PF.3 was most superior. PF.3 prostheses had the least horizontal error than the other prostheses.

CONCLUSIONS

All interim prostheses experienced errors at the vertical, horizontal, and proximal surfaces, which can be attributed to deviations of the inserted implants. The PF of interim prosthesis with increased internal spacing for intraoral insertion appeared to reduce seating errors.

Improving the practicality of recombinant Escherichia coli biosensor in detecting trace Cr(VI) by modifying the cryogenic storage conditions of biosensors and applying simple pretreatment

Hexavalent chromium (Cr(VI)) is a global environmental pollutant. To reduce the risk caused by Cr(VI), a simple, accurate, reproducible, and inexpensive method for quantifying Cr(VI) in water and soil should be developed. In this study, three types of recombinant Escherichia coli biosensors (namely T7-lux-E. coli, T3-lux-E. coli, and SP6-lux-E. coli biosensor) containing promoters (T7, T3, and SP6), chromate-sensing regulator chrB, and the reporter gene luxAB were constructed. This study investigated the effects of cryogenic freezing temperature and time on trace Cr(VI) measurement by using recombinant E. coli biosensors. The results indicated that the activity of thawed frozen SP6-lux-E. coli cells stored at -20 °C for 270 days did not differ from that of freshly prepared cells. Turbidity and conductivity in water samples and organic matter in soil interfered with Cr(VI) measurement using the biosensor. The SP6-lux-E. coli biosensor exhibited a wide measurement range and a low deviation of <5% for measuring Cr(VI) in various Cr(VI)-contaminated water and soil samples and required only a simple pretreatment or extraction process even after 270-day storage at -20 °C. To the best of our knowledge, this is the first study to report the use of recombinant biosensors for accurately measuring Cr(VI) in both water and soil.

Parallelisms and deviations: two fundamentals of an aesthetics of poetic diction

Poetic diction routinely involves two complementary classes of features: (i) parallelisms, i.e. repetitive patterns (rhyme, metre, alliteration, etc.) that enhance the predictability of upcoming words, and (ii) poetic deviations that challenge standard expectations/predictions regarding regular word form and order. The present study investigated how these two prediction-modulating fundamentals of poetic diction affect the cognitive processing and aesthetic evaluation of poems, humoristic couplets and proverbs. We developed quantitative measures of these two groups of text features. Across the three text genres, higher deviation scores reduced both comprehensibility and aesthetic liking whereas higher parallelism scores enhanced these. The positive effects of parallelism are significantly stronger than the concurrent negative effects of the features of deviation. These results are in accord with the hypothesis that art reception involves an interplay of prediction errors and prediction error minimization, with the latter paving the way for processing fluency and aesthetic liking. This article is part of the theme issue 'Art, aesthetics and predictive processing: theoretical and empirical perspectives'.

Effect of pilot-guided implant placement concept on the accuracy of osteotomy preparation and implant placement

PURPOSE

To evaluate the accuracy of osteotomy preparation and implant placement for 3 pilot-guided (PG) concepts, namely, a surgical template with a metal sleeve (MS), a surgical template with an in-built nonmetal sleeve (NMS), and a surgical template with an in-built nonmetal sleeve for round bur indentation (RB).

METHODS

Surgical models with missing maxillary molars were studied. The MS templates were designed to accept metal sleeves, while the NMS and RB templates were designed with in-built nonmetal sleeves. Ten templates were tested per group (n = 10). After each step (pilot drilling, 2nd drilling, 3rd drilling, profiling, and implant placement), the surgical model was scanned and compared against the planning model to determine maximum horizontal deviation (MHD) and maximum angle deviation (MAD).

RESULTS

The MS and NMS templates exhibited a similar increase in MHD with successive drilling steps. The MAD for the pilot drilling step was significantly lower for MS than for the other groups. However, the differences among groups for MHD and MAD diminished in later steps. All templates had an MHD of 1.0 mm or less and an MAD less than 8°.

CONCLUSION

The investigated PG implant placement concepts resulted in similar deviations in the placed implants.

Evaluation of the Surface Topography and Deformation of Vertical Thin-Wall Milled Samples from the Nickel Alloy Inconel 625

During the production of components, manufacturers of structures are obliged to meet certain requirements and ensure appropriate quality characteristics. It is especially important during the manufacturing of thin-walled structures, which are subject to many errors during machining due to the reduced rigidity of the products, including the deformation of thin walls, which may be the result of the vibration of the system. The appearance of vibrations reduces the quality of the machined surface affecting the increase in the values of surface topography parameters-waviness and roughness. Thin-wall structures-titanium or nickel alloy, among others-play a key role in the aerospace industry, which constantly strives to reduce the weight of the entire structure while meeting requirements. The present work focuses on the evaluation of the parameters of surface topography, dimensional and shape accuracy during the milling of nickel alloy Inconel 625 samples containing a thin wall in a vertical orientation. The experiment was conducted under controlled cutting conditions using a constant material removal rate. As part of the surface topography section, the distribution of waviness, Wa and Wz, and roughness, Ra and Rz, was determined in selected measurement areas in the direction parallel to the direction of the feed motion. Dimensional deviations, measured with a 3D optical scanner, were determined in selected cross sections in the direction perpendicular and parallel to the bottom of the sample presenting the deflection of the thin-walled structure. The results provide information that the used parameter sets affect the measured quantities to varying degrees.

Clinical accuracy of partially guided implant placement in edentulous patients: A computed tomography-based retrospective study

OBJECTIVES

This retrospective study was intended to evaluate the clinical accuracy of partially guided template in guiding implant placement in edentulous patients.

METHODS

A total of 120 implants were placed in 24 patients with at least one completely edentulous arch with a partially guided system. Based on CBCT data, a repeatable method was used to measure linear and angular deviations of implants at 3D level in Mimics medical software. The influence of supporting tissue and implant region on the accuracy was assessed, followed by the evaluation of direction of linear deviations in biologically vital areas.

RESULTS

Linear deviations of all implants were 1.91 ± 0.68 mm, 1.47 ± 0.68 mm, and 1.02 ± 0.69 mm at apical, apical lateral, and apical vertical levels. When at the cervical, cervical lateral, and cervical vertical levels, the linear deviations were 1.53 ± 0.65 mm, 0.98 ± 0.53 mm, and 1.01 ± 0.69 mm, respectively. Angular deviation of all implants was 7.14 ± 3.41°. Implants guided by mucosa + tooth-supported templates showed higher linear deviations at apical vertical level (1.21 ± 0.72 mm vs. 0.86 ± 0.63 mm, p < .05) and cervical vertical level (1.18 ± 0.72 mm vs. 0.87 ± 0.63 mm, p < .05) than mucosa-supported templates, and implants in maxilla were found higher angular deviation than mandible (7.89 ± 3.61° vs. 6.29 ± 2.97°, p < .05).

CONCLUSIONS

The partially guided template served as clinically viable surgical assistance in implant placement in edentulous patients. When using mucosa + tooth-supported template or placing implants in maxilla, more caution was required, especially in biologically vital areas.

EsophAguS Deviation During RadiofrequencY Ablation of Atrial Fibrillation: The EASY AF Trial

BACKGROUND

Injury to the esophagus has been reported in a high percentage of patients undergoing ablation of atrial fibrillation (AF).

OBJECTIVES

This study assessed the incidence of esophageal injury in patients undergoing ablation of AF with and without an esophageal deviating device.

METHODS

This prospective, randomized, multicenter, double-blinded, controlled Food and Drug Administration investigational device exemption trial compared the incidence of ablation-related esophageal lesions, as assessed by endoscopy, in patients undergoing AF ablation assigned to a control group (luminal esophageal temperature [LET] monitoring alone) compared with patients randomized to a deviation group (esophagus deviation device + LET). This novel deviating device uses vacuum suction and mechanical deflection to deviate a segment of the esophagus, including the trailing edge.

RESULTS

The data safety and monitoring board recommended stopping the study early after randomizing 120 patients due to deviating device efficacy. The primary study endpoint, ablation injury to the esophageal mucosa, was significantly less in the deviation group (5.7%) in comparison to the control group (35.4%; P < 0.0001). Control patients had a significantly higher severity and greater number of ablation lesions per patient. There was no adverse event assigned to the device. By multivariable analysis, the only feature associated with reduced esophageal lesions was randomization to deviating device (OR: 0.13; 95% CI: 0.04-0.46; P = 0.001). Among control subjects, there was no difference in esophageal lesions with high power/short duration (31.8%) vs other radiofrequency techniques (37.2%; P = 0.79).

CONCLUSIONS

The use of an esophageal deviating device resulted in a significant reduction in ablation-related esophageal lesions without any adverse events.

Osteochondroma of the Mandibular Condyle: A Rare Case Presentation With Literature Review

Osteochondromas (OCs) are benign bone tumors characterized by their growth with a cartilage cap and typically occurring at the ends of long bones. Their occurrence in the head and neck region is infrequent, accounting for only around 1% of head and neck tumors. Notably, the mandibular coronoid process and the mandibular condyle are the primary sites where an OC is reported. Patients often exhibit facial asymmetry, limited mouth opening, and malocclusion. Possible treatment options depending on the condition include partial or total condylectomy, vertical ramus osteotomy, and supplementary orthognathic surgery. The recurrence rate of under 1%- 2% is reported after local resection.  In this case report, we present a unique case of an OC in a 27-year-old woman. It involved the mandibular condyle, resulting in a left-sided mouth deviation while opening and closing her mouth. The purpose of this article is to detail the clinical and radiographic features, histopathological aspects, and treatment strategies and differentiate potential diagnoses, for such OCs.

Dimensional Deviations of Horizontal Thin Wall of Titanium Alloy Ti6Al4V Determined by Optical and Contact Methods

Thin-walled structures are used in many industries. The need to use such elements is dictated by the desire to reduce the weight of the finished product, as well as to reduce its cost. The most common method of machining such elements is the use of milling, which makes it possible to make a product of almost any shape. However, several undesirable phenomena occur during the milling of thin-walled structures. The main phenomenon is a deformation of the thin wall resulting from its reduced stiffness. Therefore, it is necessary to control the dimensional and shape accuracy of finished products, which is carried out using various measuring instruments. The development of newer measuring methods such as optical methods is being observed. One of the newer measuring machines is the 3D optical scanner. In the present experiment, thin-walled samples in horizontal orientation of Ti6Al4V titanium alloy were machined under controlled cutting conditions. During machining, the cutting speed and feed rate were assumed constant, while the input factors were the tool and cutting strategy. This paper presents graphs of deviations in the determined cross-section planes of thin-walled structures using a 3D optical scanner and a coordinate measuring machine. A correlation was made between the results obtained from the measurement by the optical method and those determined by the contact method. A maximum discrepancy of about 8% was observed between the methods used.

Retinal Thickness Deviation: A New OCT Parameter for Assessing Diabetic Macular Edema

(1) Purpose: To determine the "retinal thickness deviation" (RTD) in diabetic macular edema (DME) eyes treated with intravitreal therapy and to establish associations between RTD and best-corrected visual acuity (BCVA). (2) Methods: We conducted a retrospective study, including consecutive patients with DME eyes undergoing intravitreal therapy with two years of follow-up. BCVA and central subfield thickness (CST) were collected at baseline and at 12 months and 24 months of follow-up. RTD was calculated as the absolute difference between measured and normative CST values at each time point. Linear regression analyses were performed between RTD and BCVA and between CST and BCVA. (3) Results: One hundred and four eyes were included in the analysis. The RTD was 177.0 (117.2) μm at baseline, 97.0 (99.7) μm at 12 months and 89.9 (75.3) μm at 24 months of follow-up (p < 0.001). RTD showed a moderate association with BCVA at baseline (R² = 0.134, p < 0.001) and 12 months (R² = 0.197, p < 0.001) and a substantial association at 24 months (R² = 0.272, p < 0.001). The CST showed a moderate association with BCVA at baseline (R² = 0.132, p < 0.001) and 12 months (R² = 0.136, p < 0.001), while the association was weak at 24 months (R² = 0.065, p = 0.009). (4) Conclusions: RTD showed a good association with visual outcome in patients with DME eyes undergoing intravitreal treatment.

Measuring the Relative Utility Loss of Legitimacy Deviation: A Discussion Based on the Public Goods Experiment

In order to understand the differences in individual behavior across different contexts, this study introduces legitimate behavior and its deviation into a utility function. We hypothesize that people have preferences for adhering to the legitimate behavior that is required by the behavioral norm embedded in a particular context; furthermore, deviating from this legitimate behavior may generate a utility loss for them. We apply our model in the context of conditional contributions in a public goods experiment; moreover, we verify that the behavioral pattern of this conditional cooperation is derived from subjects' preferences for complying with the legitimate behavior required by the norm of the conditional cooperation activated in the experimental context. Furthermore, we attempt to measure the individual-level degrees of respect for the legitimate behavior in the given context using observable experimental data. The measurement results reveal that the subjects' relative sensitivities to deviations are highly centrally distributed; additionally, most subjects have a relatively high degree of respect for the legitimate behavior required by the conditional cooperation norm. Accordingly, this paper will help to improve our understanding of the micro mechanism underlying individual behavior.

Local regulation of antral follicle development and ovulation in monovulatory species

The identification of mutations in the genes encoding bone morphogenetic protein 15 (BMP15) and growth and differentiation factor 9 (GDF9) associated with phenotypes of sterility or increased ovulation rate in sheep aroused interest in the study of the role of local factors in preantral and antral folliculogenesis in different species. An additive mutation in the BMP15 receptor, BMPR1b, which determines an increase in the ovulatory rate, has been introduced in several sheep breeds to increase the number of lambs born. Although these mutations indicate extremely relevant functions of these factors, the literature data on the regulation of the expression and function of these proteins and their receptors are very controversial, possibly due to differences in experimental models. The present review discusses the published data and preliminary results obtained by our group on the participation of local factors in the selection of the dominant follicle, ovulation, and follicular atresia in cattle, focusing on transforming growth factors beta and their receptors. The study of the expression pattern and the functionality of proteins produced by follicular cells and their receptors will allow increasing the knowledge about this local system, known to be involved in ovarian physiopathology and with the potential to promote contraception or increase the ovulation rate in mammals.

Disorder or a new order: How climate change affects phenological variability

Advancing spring phenology is a well documented consequence of anthropogenic climate change, but it is not well understood how climate change will affect the variability of phenology year to year. Species' phenological timings reflect the adaptation to a broad suite of abiotic needs (e.g., thermal energy) and biotic interactions (e.g., predation and pollination), and changes in patterns of variability may disrupt those adaptations and interactions. Here, we present a geographically and taxonomically broad analysis of phenological shifts, temperature sensitivity, and changes in interannual variability encompassing nearly 10,000 long-term phenology time series representing more than 1000 species across much of the Northern Hemisphere. We show that the timings of leaf-out, flowering, insect first-occurrence, and bird arrival were the most sensitive to temperature variation and have advanced at the fastest pace for early-season species in colder and less seasonal regions. We did not find evidence for changing variability in warmer years in any phenophase groups, although leaf-out and flower phenology have become moderately but significantly less variable over time. Our findings suggest that climate change has not to this point fundamentally altered the patterns of interannual phenological variability.

Binocular Function in Adults before and after Strabismus Surgery

PURPOSE

To evaluate the state of binocular vision, the amount and direction of the ocular deviation before and after strabismus surgery in adult patients and to monitor the occurrence of postoperative complications.

METHODS

The retrospective study of 58 adult patients with selected types of strabismus who were surgically treated in the Eye Department of the Tomas Bata Regional Hospital in Zlín. We evaluated the amount and the degree of the primary ocular deviation and the binocular alignment before and after surgery,  as well as the state of binocular vision after surgery and the occurrence of postoperative complications.

RESULTS

The average deviation in convergent strabismus before surgery was +23.46 degrees, after surgery +6.6 degrees, in divergent strabismus it was -21.5 degrees, after surgery -1.48 degrees, for vertical strabismus before surgery +12.5 degrees and +3.75 degrees after surgery and in paralytic strabismus +20 degrees before surgery and +3 degrees postoperatively. Preoperatively there was effectively no binocular vision in up to 63.9% of patients, superposition occurred in 31%, fusion in 5.1%. No patient had stereopsis before surgery. After surgery, superposition was present in 39.7%, fusion in 31% and stereopsis in 6.9% of patients. Only 22.4% of patients experienced no binocular vision after surgery. Of the selected 21 patients out of 58 with an observation period of at least 3 years, we observed an improvement or development of binocular vision functions after surgery in 12 patients and no improvement of binocular vision functions in 9 patients. In the first group, 58.3% had a stable deviation throughout the follow-up period. While in the second group the deviation was stable in only 33.3%. We can assume that the improvement in binocular vision function after strabismus surgery, leads to a greater longer-term stability of postoperative deviations.

CONCLUSION

Strabismus surgery in adult patients is an effective and safe method, which is not only a cosmetic procedure used to adjust the position of the eyes, but also enables us to induce or improve the state of binocular vision functions.

Construction and Configuration Analysis of Zelkova Serrata Lenticel-Like Patterns Generated through DNA Algorithmic Self-Assembly

Multiple models and simulations have been proposed and performed to understand the mechanism of the various pattern formations existing in nature. However, the logical implementation of those patterns through efficient building blocks such as nanomaterials and biological molecules is rarely discussed. This study adopts a cellular automata model to generate simulation patterns (SPs) and experimental patterns (EPs) obtained from DNA lattices similar to the discrete horizontal brown-color line-like patterns on the bark of the Zelkova serrata tree, known as lenticels [observation patterns (OPs)]. SPs and EPs are generated through the implementation of six representative rules (i.e., R004, R105, R108, R110, R126, and R218) in three-input/one-output algorithmic logic gates. The EPs obtained through DNA algorithmic self-assembly are visualized by atomic force microscopy. Three different modules (A, B, and C) are introduced to analyze the similarities between the SPs, EPs, and OPs of Zelkova serrata lenticels. Each module has unique configurations with specific orientations allowing the calculation of the deviation of the SPs and the EPs with respect to the OPs within each module. The findings show that both the SP and the EP generated under R105 and R126 and analyzed with module B provide a higher similarity of Zelkova serrata lenticel-like patterns than the other four rules. This study provides a perspective regarding the use of DNA algorithmic self-assembly for the construction of various complex natural patterns.

Analysis of Occupational Accidents in the Spanish Mining Sector in the Period 2009-2018

Occupational accidents in the Spanish mining industry have been substantially reduced over the last decades. However, the incidence rate shows higher values than other leading mining countries. In this regard, the research carried out reveals the factors influencing the high incidence rates of the Spanish mining sector, based on three scenarios: underground mining (UG), quarries and open pit mining (OP) and mineral processing plants (PP). The three most common types of accident for each scenario have been determined, considering the accidents in Spain between 2009 and 2018. The analysis also includes the main deviations, and physical activities that the injured worker was carrying out at the time of the accident. Besides, a model to predict the number of accidents based on the lost working days is also presented together with the incidence and severity risk index adjusted by the number of employees and their worked hours, respectively, in each scenario. These finding can be relevant to define the most effective measures and policies to reduce the number of accidents in the mining sector.

Leftward deviation of the primary septum or dividing left atrial shelf?

Isolated leftward prolapse or deviation of the primary atrial septum is a rare CHD that can mimic abnormal pulmonary venous return at first sight. We present a case of a newborn infant, referred for surgical correction of totally anomalous pulmonary venous return into the right atrium, with the peri-operative finding of a leftward deviation of the superior margin of the primary atrial septum. The distinction with a dividing atrial shelf could not be confirmed with certainty. Fifty-three similar cases from the literature are incorporated. A detailed review of the current account on atrial septation is studied. The embryological and clinical features of a dividing partition of the left atrium are discussed.

Evaluation of the angulation of the nasal septum deviation as an anatomical variation for increased frequency of antral pseudocyst: a cone-beam computed tomography study

BACKGROUND

The aim of the study was to determine whether degree of the nasal septum deviation (NSD) can affect the frequency of antral pseudocyst (AP) formation by cone-beam computed tomography (CBCT).

MATERIALS AND METHODS

This retrospective study was included 466 CBCT images. The NSD were categorised into four groups according to the degree: control group (no NSD, 0°-2°), group A (2°-9°), group B (9°-15°), and group C (≥ 15°). The predictor variables were demographic factors (patient's age and gender) and anatomic factors (different degrees of nasal septum angulation). The outcome variable was presence of AP.

RESULTS

Of the 466 cases, 242 (51.9%) had no NSD, 66 (14.2%) had an angle of 2°-9°, 111 (23.8%) had an angle of 9°-15°, and 47 (10.1%) had an angle of over 15°. The prevalence of AP was 2.04 (95% confidence interval [CI] 1.37 to 3.03; p = 0.001) times higher in the presence of NSD. Significant increases in presence of AP occurred with NSD in group A (2.37 times higher; p = 0.003) and group B (2.07 times higher; p = 0.003) compared to control by univariate analysis.

CONCLUSIONS

Although there is no sufficient evidence to suggest that NSD is a definitive aetiological factor for AP development, our findings indicated that NSD increased the risk of AP formation.

The Characteristics of Targets of Bullying Among Chinese Youth Attending Key Versus Non-Key Schools: A Mixed-Methods Analysis

The current study examined the characteristics of targets of bullying using a sample of students from two distinct school types (key vs. non-key), wherein key middle schools are defined as having better teaching resources and higher performing students than non-key middle schools. Open-ended, self-report surveys were collected from 322 Chinese students in sixth to 11th grades. Two cycle coding methods analyses generated 3,566 original codes in which 21 main categories and 77 subcategories were extracted. Five major themes emerged: multiple deviant personalities; prominent puniness and imperfect body characteristics accompanied by polarization of appearance; polarization school engagement and academic performance; psychological and behavioral problems; and problematic family and social contexts. Results of chi-square analysis indicated characteristics of targets of bullying were significantly different between key and non-key school in 12 main categories. Implications for ecological systems theory and person-group dissimilarity theory as well as bullying prevention approaches in schools are discussed.

Pitfalls in brain age analyses

Over the past decade, there has been an abundance of research on the difference between age and age predicted using brain features, which is commonly referred to as the “brain age gap.” Researchers have identified that the brain age gap, as a linear transformation of an out‐of‐sample residual, is dependent on age. As such, any group differences on the brain age gap could simply be due to group differences on age. To mitigate the brain age gap's dependence on age, it has been proposed that age be regressed out of the brain age gap. If this modified brain age gap is treated as a corrected deviation from age, model accuracy statistics such as R² will be artificially inflated to the extent that it is highly improbable that an R² value below .85 will be obtained no matter the true model accuracy. Given the limitations of proposed brain age analyses, further theoretical work is warranted to determine the best way to quantify deviation from normality.

Accuracy and deviation analysis of robot-assisted spinal implants: A retrospective overview of 105 cases and preliminary comparison to open freehand surgery in lumbar spondylolisthesis

BACKGROUND

Whether the accuracy of robot-assisted spinal screw placement is significantly higher than that of freehand and the source of robotic deviation remain unclear.

METHODS

Clinical data of 105 patients who underwent robot-assisted spinal surgery was collected, and screw accuracy was evaluated by computed tomography according to the modified Gertzbein-Robbins classification. Patients were grouped by percutaneous and open surgery. Intergroup comparisons of clinical and screw accuracy parameters were performed. Reasons for deviation were determined. Thirty-one patients with lumbar spondylolisthesis undergoing open robot-assisted surgery and the same number of patients treated by open freehand surgery were compared for screw accuracy.

RESULTS

Screw accuracy was not significantly different between the percutaneous and open groups in both intra- and postoperative evaluations. Tool skiving was identified as the main cause of deviation. The proportion of malpositioned screws (grade B + C + D) was significantly higher in the freehand group than in the robot-assisted group. However, remarkably malpositioned (grade C + D) screws showed no significant differences between the groups. No revision surgery was necessary.

CONCLUSIONS

Robot-assisted spinal instrumentation manifests high accuracy and low incidence of nerve injury. Tool skiving is a major cause of implant deviation.

Accuracy of static computer-assisted implant placement in long span edentulous area by novice implant clinicians: A cross-sectional in vitro study comparing fully-guided, pilot-guided, and freehand implant placement protocols

BACKGROUND

To ensure accurate implant placement, surgical guides are used to control the steps of implant placement surgery.

PURPOSE

Evaluation of the accuracy of implant placement in long span edentulous area by novice implant clinicians according to fully-guided (FG), pilot-guided (PG), and freehand (FH) placement protocols.

MATERIALS AND METHODS

Maxillary surgical models with four missing teeth from the right first canine to the first molar were produced by 3-dimensional printing. Fourteen clinicians new to implant dentistry participated in the study, and each one of them inserted one canine and one molar implant for every implant placement protocol. All implant placement steps were completed in phantom heads to simulate the clinical situation. To evaluate the accuracy, the implant vertical, horizontal platform, horizontal apex, angle, and interimplant distance deviations from the planned positions were calculated.

RESULTS

With the exception of vertical deviation, the FG placement was clearly more accurate than the PG and FH placements for all the variables for canine and molar implants. The PG placement was significantly more accurate than the FH placement for the horizontal platform and apex deviations, and interimplant distance deviation. The FG placement did not show a significant impact of the location of the implant, or the horizontal deviations of the platform or the apex. The PG and FH placements showed increased deviation at the canine implant than the molar implant, and at the apex of the implants than the platform of the implants.

CONCLUSIONS

Within the limitations of this in vitro study, novice clinicians achieved a significantly more accurate implant position with FG placement, followed by PG and FH placements respectively. Therefore, a form of guided surgery is beneficial for novice clinicians.

Facilitating recall and particularisation of repeated events in adults using a multi-method interviewing format

Reports about repeated experiences tend to include more schematic information than information about specific instances. However, investigators in both forensic and intelligence settings typically seek specific over general information. We tested a multi-method interviewing format (MMIF) to facilitate recall and particularisation of repeated events through the use of the self-generated cues mnemonic, the timeline technique, and follow-up questions. Over separate sessions, 150 adult participants watched four scripted films depicting a series of meetings in which a terrorist group planned attacks and planted explosive devices. For half of our sample, the third witnessed event included two deviations (one new detail and one changed detail). A week later, participants provided their account using the MMIF, the timeline technique with self-generated cues, or a free recall format followed by open-ended questions. As expected, more information was reported overall in the MMIF condition compared to the other format conditions, for two types of details, correct details, and correct gist details. The reporting of internal intrusions was comparable across format conditions. Contrary to hypotheses, the presence of deviations did not benefit recall or source monitoring. Our findings have implications for information elicitation in applied settings and for future research on adults' retrieval of repeated events.

[Evaluation of the diet based on the variability of the food composition data]

Nutrient composition is a necessary part in the assessing of nutritional value of diets and new foods. According to the results of comparison of nutrient value of the diet with daily requirements the judgment on compliance of the diet (or product) to norm or deviation from the standard is taken out. In the interpretation of the term "value corresponds to the norm" in modern practice, only average values are used, while the content of nutrients in food is not described by fixed values, but has a statistical nature, which creates difficulties in the conscientious development of diets and their harmonization in sanitary authorities. Specifying a range of normative values (±5-10%) does not provide a valid solution. The aim of the research was to assess the size of the spread of nutrient content for the diet as a whole and to use this estimate in relation to the task of "comparing the actual value and the norm". Material and methods. In this work, we used the method of mathematical modeling of recipes, the calculation of nutrient content based on that of ingredients, and reference publications on the nutrient composition of products and collections of recipes were used as starting materials. Results and discussion. The calculation of nutrient composition according to the recipe is described, taking into account not only average values, but also scatter indicators (error) of nutrient content values, which makes it possible to reasonably make judgments about the compliance of the actual value with the established reference value. The calculation of estimates of the spread of nutrient composition values using the information about the error of the initial data on the nutrient composition of the products, the output of the absolute and relative error in the formulation and the whole diet was described. Examples of calculations of scatter estimates are given: for one recipe/ nutrient (primary); calculation for days and mealtimes; for a day of a cyclic menu and for a 4-week cycle of school meals menus (primary and secondary school age). The mapping of the variables having a statistical nature has been graphically showed, the measure of estimating the proximity of the values of the statistical nature has been proposed discrete and continuous. Comparison of indicators of variability of domestic and foreign reference databases, mapping information about variation in the types of meals, differences in the extent of variation in the nutrients has been given. Conclusions. The conclusions are formulated on the need for statistical presentation of consumption reference values for research for various reasons of variability, on the need to take statistics into account for the system of accumulating data on nutrient composition in databases.

Risk-adjusted hospital clinical management issue rates using data from the Victorian Audit of Surgical Mortality

BACKGROUND

In recent years, there has been a concerted drive for an increase in public reporting of hospital-level outcomes as a means of identifying strategies to improve patient safety. Surgical care, as a high-risk area of medical practice, has come under sharp scrutiny. This study uses data from the Victorian Audit of Surgical Mortality (VASM) in conjunction with data from the Victorian Admitted Episode Dataset to compare hospital rates of clinically identified serious clinical management issues that were definitely or probably preventable and caused or contributed to the death of the patient who would otherwise be expected to survive.

METHODS

Cases where the date of death was between 1 July 2015 and 30 June 2017 that completed the full VASM audit process were extracted from the VASM database and combined with data extracted from the Victorian Admitted Episode Dataset, where a surgical admission occurred in the same time period. A logistic regression model was used as a method of indirect standardization to derive the probability of preventable clinical management issues, which was then used to calculate the standardized incident rate for all Victorian surgical hospitals. Hospitals were compared by plotting the standardized incident rates on three funnel plots.

RESULTS

There were five hospitals (8.3%) of the 60 that deviated significantly from the state-wide rate of 0.00012.

CONCLUSION

The risk adjustment model identified several hospitals that may have a systematic issue which warrant further clinical quality assurance investigation.

The Role of Egg Production in the Etiology of Keel Bone Damage in Laying Hens

Keel bone fractures and deviations belong to the most severe animal welfare problems in laying hens and are influenced by several factors such as husbandry system and genetic background. It is likely that egg production also influences keel bone health due to the high demand of calcium for the eggshell, which is, in part, taken from the skeleton. The high estrogen plasma concentration, which is linked to the high laying performance, may also affect the keel bone as sexual steroids have been shown to influence bone health. The aim of this study was to investigate the relationship between egg production, genetically determined high laying performance, estradiol-17ß concentration, and keel bone characteristics. Two hundred hens of two layer lines differing in laying performance (WLA: high performing; G11: low performing) were divided into four treatment groups: Group S received an implant containing a GnRH agonist that suppressed egg production, group E received an implant containing the sexual steroid estradiol-17ß, group SE received both implants, and group C were kept as control hens. Between the 12th and the 62nd weeks of age, the keel bone of all hens was radiographed and estradiol-17ß plasma concentration was assessed at regular intervals. Non-egg laying hens showed a lower risk of keel bone fracture and a higher radiographic density compared to egg laying hens. Exogenous estradiol-17ß was associated with a moderately higher risk of fracture within egg laying but with a lower risk of fracture and a higher radiographic density within non-egg laying hens. The high performing layer line WLA showed a significantly higher fracture risk but also a higher radiographic density compared to the low performing layer line G11. In contrast, neither the risk nor the severity of deviations were unambiguously influenced by egg production or layer line. We assume that within a layer line, there is a strong association between egg production and keel bone fractures, and, possibly, bone mineral density, but not between egg production and deviations. Moreover, our results confirm that genetic background influences fracture prevalence and indicate that the selection for high laying performance may negatively influence keel bone health.

Understanding basic concepts of developmental diagnosis in children

Developmental diagnosis is based on an understanding of basic concepts of typical and atypical developmental progression. Child development is influenced by multiple factors, including the development of the nervous system and other organ systems, and the child's physical and social environment. Different factors interplay with each other in influencing the overall development of the child. Development and behavior of the child are intricately associated. Typical child development follows certain basic principles. Some of the more commonly reported developmental concerns include global developmental delay, intellectual disability, cerebral palsy, delayed speech and language, attention deficits, autism, and specific learning disabilities. The clinical presentation of atypical development varies, depending up on the age of the child; with motor delay in early infancy, and learning difficulties in school age child. Regular surveillance and periodic screening help identify specific areas of developmental and behavioral concerns and suggest a need for further appropriate psychological, medical and laboratory evaluation. The principles of management of a child with developmental concerns include early intervention and response to treatment approach, remediation, accommodation, and specific behavioral and pharmacological interventions when indicated.

A series of unfortunate events: characterizing the contingent nature of physiological extremes using long-term environmental records

Accelerating shifts in global climate have focused the attention of ecologists and physiologists on extreme environmental events. However, the dynamic process of physiological acclimatization complicates study of these events' consequences. Depending on the range of plasticity and the amplitude and speed of environmental variation, physiology can be either in tune with the surroundings or dangerously out of synch. We implement a modified quantitative approach to identifying extreme events in environmental records, proposing that organisms are stressed by deviations of the environment from the current level of acclimatization, rather than by the environment's absolute state. This approach facilitates an unambiguous null model for the consequences of environmental variation, identifying a unique subset of events as 'extremes'. Specifically, it allows one to examine how both the temporal extent (the acclimatization window) and type of an environmental signal affect the magnitude and timing of extreme environmental events. For example, if physiology responds to the moving average of past conditions, a longer acclimatization window generally results in greater imposed stress. If instead physiology responds to historical maxima, longer acclimatization windows reduce imposed stress, albeit perhaps at greater constitutive cost. This approach should be further informed and tested with empirical experiments addressing the history-dependent nature of acclimatization.

Body Weight Deviations as Indicator for Resilience in Layer Chickens

Resilience is the capacity of an animal to be minimally affected by disturbances or to rapidly return to the state pertained before exposure to a disturbance. Less resilient animals are expected to be more susceptible to environmental perturbations, such as diseases, and will consequently show more and/or greater fluctuations in production than more resilient animals. Natural antibodies (NAb) are antibodies recognizing antigens without previous exposure to these, and are hypothesized to be an indication of general disease resistance. The objective of this research was to investigate genetic parameters of resilience indicators based on standardized body weight (BW) deviations and to investigate its relation with immunity (i.e. NAb) and disease resistance. Keyhole limpet hemocyanin-binding NAb were measured in layer chickens, which were selectively bred for high and low keyhole limpet hemocyanin-binding NAb levels during six generations. In addition, BW data of these layers were collected on a four-weekly interval from 4 weeks of age until 32 weeks of age. Standardized deviations of BW from an individual were compared to lines’ average BW (i.e. across individuals), and these were used to calculate resilience indicators: natural logarithm-transformed variance [ln(variance)], skewness, and lag-one autocorrelation of deviations (i.e. all within an individual). Heritabilities of resilience indicators were between 0.09 and 0.11. Genetic correlations between the three resilience indicators were between -0.20 and 0.40 (with high SE), which might suggest that the resilience indicators capture different aspects of resilience. Genetic correlations between resilience indicators and NAb were close to zero, which suggests that the resilience indicators and NAb capture different aspects of immunity. This might indicate that, in this dataset, environmental perturbations are only to a small extent affected by disease incidence, possibly due to a lack of disease occurrence. However, a lower estimated breeding value for ln(variance) was predictive for lower lesion scores after an avian pathogenic Escherichia coli inoculation and vice versa. In conclusion, this study shows that there is genetic variation in resilience indicators based on BW deviations in layer chickens, which opens up possibilities to improve resilience by means of selective breeding.

Compliance to treatment guidelines and survival in women undergoing interval debulking surgery for advanced epithelial ovarian cancer

BACKGROUND

One of the primary treatment strategies for advanced epithelial ovarian cancers includes neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) and adjuvant chemotherapy. Compliance to treatment is important to possibly improve outcomes.

AIM

To audit treatment compliance and its effect on overall survival (OS) and disease free survival (DFS) in women undergoing IDS.

METHODS AND RESULTS

Women diagnosed with advanced epithelial ovarian cancer undergoing IDS were included. Details of compliance to chemotherapy and surgery as per standard guidelines were assessed, and correlation with survival was studied. Reasons for protocol deviation at various levels were documented and analysed. A total of 182 patients were included. The total number of deviations was 134 with deviation at any level being 89 (48.9%) and at all levels 5%. Both patient- and treatment-related factors contributed towards deviation. Deviation or noncompliance towards treatment resulted in a significantly reduced 5-year OS (34.4% vs 58.2%; P = .001) compared with compliant patients, which retained its significance on multivariate analysis (P = .024) as well.

CONCLUSION

Deviation from treatment guidelines resulted in a significantly lower 5-year OS compared with those who remained treatment compliant. Both patient- and treatment-related factors contributed towards noncompliance and hence towards lower survival.

[Discussion on evaluation mode of proficiency testing for heavy metal and harmful element detection in medicines]

This study aims to explore the evaluation model for the proficiency testing of heavy metal and harmful element residues in pharmaceuticals,and to provide reference for the proficiency testing program and proficiency testing result in the field of residue analysis. The proficiency test result of cadmium determination in honeysuckle as an example. The algorithm A,NIQR,and Horwitz function are used to calculate the assigned value and the standard deviation. Z was obtained at the same time. If | Z | ≤2,the result is satisfactory. If 2< | Z | <3,the result is questionable. If | Z | ≥3,the result is unsatisfactory. In addition,the median value is the assigned value,and deviation(D%) is used. If D% is not more than 16%,the result is satisfactory; if D% is more than 16%,the result is unsatisfactory. After analysis,in the results of questionable or dissatisfied laboratories calculated by algorithm A and NIQR,the deviation error of some data is within the scope of the standard. In the results of the satisfactory laboratory evaluated by the Horwitz function,some data deviation errors far exceed the standard range. The evaluation result of the D% meets the requirements. According to heavy metal and harmful element trace analysis methods,this study is the first to apply D% to the evaluation of the detection ability of heavy metals and harmful elements in pharmaceuticals. This method makes the evaluation result more reasonable,and has important reference significance for the evaluation of other proficiency test results.

Assessing keel bone damage in laying hens by palpation: effects of assessor experience on accuracy, inter-rater agreement and intra-rater consistency

Accurate assessment is essential when evaluating keel bone damage. Palpation is commonly used to assess keel bone damage in living hens. However, there is little information on the accuracy of assessment of deviations and fractures on different parts of the keel, and on the consistency within, and agreement between, assessors. Crucially, although the importance of experience is commonly emphasized, knowledge on its effect is scarce. Ten assessors with or without prior experience palpated the same 50 75-wk-old hens for deviations, medial fractures, and caudal fractures (scored as present/absent). Accuracy, sensitivity, specificity, precision, and negative predictive value were determined by comparing palpation scores to post-dissection assessment, and then compared between experienced and inexperienced assessors. To determine the effect of the experience gained during the experiment, hens were subsequently re-assessed. Consistency within, and agreement between, assessors were also determined. Assessors with prior experience were more accurate (proportion of accurately assessed deviations: experienced 0.83 vs. inexperienced 0.79±0.01, P = 0.04; medial fractures: 0.82 vs. 0.68±0.03 in session 1 only, P = 0.04; caudal fractures: 0.41 vs. 0.29±0.03, P = 0.03), and inexperienced assessors classified medial fractures more accurately in session 2 (session 1: 0.68 vs. session 2: 0.77±0.04, P = 0.04). However, effect sizes were small for deviations and even experienced assessors lacked accuracy when assessing caudal fractures. Unexpectedly, deviations tended to be assessed more accurately in session 1 than in session 2, regardless of assessor status (1: 0.83 vs. 2: 0.79±0.01, P = 0.06), suggesting that prolonged assessment contributes to errors. Prior experience decreased specificity and precision of fracture assessment (more unfractured keels were classified as fractured) even though overall accuracy was greater. Intra-rater consistency was fair to good (0.55 to 0.67) for deviations and medial fractures, but poor to fair (0.36 to 0.44) for caudal fractures, and unaffected by prior experience (P = 0.49 to 0.89). In conclusion, experience improves accuracy to a limited extent but does not guarantee high accuracy for all types of damage. Future research should determine if other training methods (e.g., comparison to post-dissection scores or to radiographs) improve accuracy.

Lesser Metatarsophalangeal Joint Pathology Addressed With Arthrodesis: A Case Series

Lesser metatarsophalangeal joint pathology is a common condition facing the foot and ankle surgeon, often beginning as a mild subluxation of the toe and progressing to a full dislocation of the metatarsophalangeal joint. In severe or recalcitrant deformities, traditional conservative and surgical methods can fail to resolve the issue. We report on 4 patients with 5 severely dislocated lesser metatarsophalangeal joints with varied etiologies and comorbidities who underwent arthrodesis of these joints using screw and plate fixation. All patients achieved radiographic and clinical signs of union at an average of 16.4 weeks.

A novel method for complex three-dimensional evaluation of intraoral scanner accuracy

AIMS

The aim of this study was to compare two existing methods and one novel method for measuring the distortion of three-dimensional (3D) models created with complete-arch digital impressions, and to assess the accuracy of different scan patterns using these methods.

MATERIALS AND METHODS

Maxillary and mandibular models were imaged with the PlanScan intraoral scanner using four different scan patterns. Accuracy and distortion were assessed by comparing the master scans with the intraoral scans using the following three methods: 1) Mean surface deviation was measured after complete arch superimposition; 2) 28 points were selected identically on the experimental and on the master reference models, and the deviation between identical points was assessed after superimposition over the complete arch; 3) In the case of the novel technique, the superimposition was made only at the scanning origin, and after that the 28 points were compared.

RESULTS

Significant differences were found between the three different methods, regardless of the arch and pattern. The overall mean deviation between identical points when the models were aligned at the scanning origin was the highest, and the mean deviation between the non-identical values was the lowest. The novel method revealed local tooth-wise differences between the scan patterns as well as a pattern of amplified model error extending away from the scan origin.

CONCLUSIONS

The novel method better detects the cumulative deviation of stitching errors in complete arch intraoral scans and is suitable to investigate the effect of scanning pattern in a very sensitive manner.

Incidence of re-deviated nasal septum after septoplasty in adolescent and adult patients

BACKGROUND

Re-deviation of the nasal septum may occur after septoplasty. Because the cartilaginous septum grows until the age of 16-17 years, septoplasty is usually recommended thereafter. However, severely deviated septum may necessitate septoplasty in younger adolescents.

OBJECTIVES

To compare the incidence of re-deviated nasal septum in patients who underwent septoplasty at ≤18 versus ≥19 years of age.

MATERIALS AND METHODS

The medical records and endoscopic photographs of patients who underwent septoplasty between 2005 and 2015 were retrospectively reviewed. Re-deviation of the nasal septum was defined as >50% narrowing of one side of the nasal cavity compared to immediately after septoplasty.

RESULTS

The inclusion criteria were met by 52 adolescent patients and 549 adult patients. Re-deviation of the septum occurred in 11 (21.2%) and 39 (7.1%) patients, respectively; the difference was significant. Most patients had caudal and upper cartilaginous deviations. Four adolescent and 14 adult patients underwent revisional septoplasty.

CONCLUSIONS AND SIGNIFICANCE

Adolescent patients who underwent septoplasty had a significantly higher incidence of re-deviation of the nasal septum than adult patients. Therefore, when septoplasty is deemed necessary in adolescent patients, they and their parents should be informed about the possibility of re-deviation and the need for revisional septoplasty.

Establishment of an acute extraocular muscle injury model in cats

AIM

To describe an acute extraocular muscle injury model in cats.

METHODS

Seventy-two cats were randomly divided into 6 groups (12 cats per group). Cats' left lateral recti were clamped using a surgical needle holder with a clamping strength of 2 (Groups A and D), 4 (Groups B and E) and 6 kg (Groups C and F). The right lateral recti were treated as controls. On the 4th and 7th days, hematoxylin eosin (HE) staining, immunohistochemical staining for proliferating cell nuclear antigen (PCNA), muscle force measurements and ocular alignment changes were performed to evaluate the extent of injuries.

RESULTS

The morphological changes were graded as mild, moderate or severe by HE staining in all experiment groups. PCNA immunohistochemical staining indicated repairment of muscle fibers in the damaged area. On the 4th and 7th days after clamping, the injured lateral muscle exhibited an elevated threshold for electric stimulation. The muscle forces among groups 2, 4 and 6 kg injury at 4d (Groups A, B and C) were statistically significant (P<0.05), but no significant differences were noted among groups 2, 4 and 6 kg injury at 7d (Groups D, E and F) (P>0.05), respectively. In addition, medial deviation in ocular alignment was also present to various degrees in all groups.

CONCLUSION

A cat model of acute extraocular muscle injury can be established by rectus clamping. Different clamping strengths can make different degrees of muscle injury. This model may help the future study in the acute extraocular muscle injury.

Research Deviations in FDA-Regulated Clinical Trials: A Cross-Sectional Analysis of FDA Inspection Citations

BACKGROUND

The US Food and Drug Administration (FDA) ensures clinical trials meet regulatory/ethical standards through inspections. If FDA Investigators observe potential violations of regulatory requirements during an inspection, a firm will receive a Form FDA 483, Inspectional Observations. Violations cited have resulted in the death of human research subjects, prosecution of research personnel, and denial of approval for new medical products. Objectives included the standardization of Violation Themes cited for analysis by inspection firm type, geographic location, and Violation Theme citation to provide insight into regulatory violations.

METHODS

Cross-sectional analysis of citations published in public databases between October 1, 2005, and September 30, 2015, by the FDA for inspections under the Bioresearch Monitoring program. For each inspection citation, the main measure was the Code of Federal Regulation cited coded into a standardized Violation Theme for citation analysis.

RESULTS

Under the Bioresearch Monitoring program, 3281 inspections received a Form FDA 483 in 2007-2015. FDA inspections have increased over this period but the rate of Form FDA 483 issuance has decreased. On average, Sponsor-Investigators received 4.41 citations per inspection compared to clinical researchers alone receiving 2.21. One-third of violations were related to adherence to investigational procedures followed by informed consent and study records issues.

CONCLUSIONS

In the last decade, the number of violations observed under the Bioresearch Monitoring program has decreased; however, significant improvements can still be made regarding adherence to study procedures, the consenting of human research subjects, and creation of adequate and accurate study documentation.

Correlation between clinical severity and type and degree of pectus excavatum in twelve brachycephalic dogs

The aim of the study was to correlate the clinical severity of pectus excavatum with its type and degree based on objective radiographic evaluation. Twelve brachycephalic dogs were included. Grading of the clinical severity was done based on a 6-point grading score. Thoracic radiographs were used to calculate the frontosagittal and vertebral indices at the tenth thoracic vertebra and the vertebra overlying the excavatum. Correlation between the clinical severity score and frontosagittal and vertebral indices was evaluated using Pearson’s correlation coefficient. Typical pectus excavatum was recorded in the caudal sternum in seven dogs, with a mean clinical severity score of 1.7 ± 1.4, whereas in five dogs, atypical mid-sternal deviation was recorded with a mean clinical severity score of 3.8 ± 0.7. A strong correlation (r=0.7) was recorded between the clinical severity score and vertebral index in the atypical form, whereas a weak correlation (r=0.02) was recorded in the typical form (P<0.05). The clinical severity and degree of pectus excavatum was poorly correlated (r=0.3) in the typical form of pectus excavatum, whereas it was strongly correlated (r=0.9) in the atypical form. Pectus excavatum in dogs is associated with compressive cardiopulmonary dysfunction, which depends mainly on the site/type of deviation rather than the degree of deviation.

Existence of a squamous cell carcinoma antigen-immunoglobulin complex causes a deviation between squamous cell carcinoma antigen concentrations determined using two different immunoassays: first report of squamous cell carcinoma antigen coupling with immunoglobulin A

Background Squamous cell carcinoma antigen is used as a tumour marker and is routinely measured in clinical laboratories. We validated two different immunoassays and found three cases in which the squamous cell carcinoma antigen concentrations deviated greatly between the two immunoassays. Here, we aimed to elucidate the mechanisms responsible for these deviations. Methods The squamous cell carcinoma antigen concentrations were determined using the ARCHITECT SCC (CLIA method) and the ST AIA-PACK SCC (FEIA method). We performed polyethylene glycol precipitation and size exclusion chromatography to assess the molecular weight and spike recovery and absorption tests to examine the presence of an autoantibody. Results Both methods exhibited good performances for the measurement of squamous cell carcinoma antigen, although a correlation test showed large differences in the squamous cell carcinoma antigen concentrations measured using the two methods in three cases. The results of polyethylene glycol treatment and size exclusion chromatography indicated the existence of a large molecular weight squamous cell carcinoma antigen in these three cases. The spike recovery tests suggested the possible presence of an autoantibody against squamous cell carcinoma antigen. Moreover, the absorption test revealed that large squamous cell carcinoma antigen complexes were formed by the association of squamous cell carcinoma antigen with IgG in two cases and with both IgG and IgA in one case. Conclusions This study describes the existence of large molecular weight squamous cell carcinoma antigen that has complexed with immunoglobulin in the serum samples. The reason for the deviations between the two immunoassays might be due to differences of their reactivities against the squamous cell carcinoma antigen immune complexes with their autoantibody. To our knowledge, this is the first report to describe the coupling of squamous cell carcinoma antigen with IgA.

The Role of Burden and Deviation in Ostracizing Others

Ostracism (being excluded and ignored) is a painful experience, so why do individuals ostracize others? Previous research suggests individuals often ostracize those who are deviate, but not always. We posit that there may be two types of deviation, burdensome and non-burdensome, and the former is most likely to be ostracized. Study 1 manipulated burdensome deviation by programming a group member to perform more slowly (8 or 16 sec.) than others (4 sec.) in a virtual ball-toss game. Participants perceived slower players as more burdensome and deviate than normal speed players. Additionally, participants ostracized (gave fewer ball tosses to) the slowest player. Study 2 examined participant responses to both burdensome deviation (8- and 16-sec. players) and non-burdensome deviation (goth appearance). Participants again perceived the slower players to be burdensome and deviate, and ostracized them. They perceived the goth player to be deviate but not burdensome and did not ostracize this player.

Conjugate Eye Deviation on CT Associated With Worse Outcomes Despite IV Thrombolysis

INTRODUCTION

Rapid stroke management has significant implications in patient outcomes. Ipsilateral computed tomography conjugate eye deviation (CT-CED) has been associated with worse outcomes but has never been evaluated as predictive of vascular occlusion. To test the hypothesis that CT-CED is a marker for vascular occlusion, we evaluated patients treated with intravenous tissue plasminogen activator (IV tPA).

METHODS

We performed a retrospective analysis of patients with acute ischemic stroke treated with IV tPA at a large tertiary care hospital over an 18-month period. A waiver of informed consent was granted. Two examiners evaluated baseline brain CTs blinded to the location of infarct to assess the presence of CT-CED and follow-up imaging for the location of infarct and the presence of intracranial large vessel occlusion. Demographics, initial National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scales (mRSs), and hospital length of stay (LOS) were collected.

RESULTS

Among 104 patients treated with IV tPA, 36 had CT-CED. Inter-rater reliability for CT-CED was excellent (κ = 0.97; 95% confidence interval: 0.98-1.0). The CT-CED group was older (69.8 vs 64 years; P = .038), had higher initial NIHSS (14.6 vs 11; P = .01), worse mRS (3.2 vs 2.4; P = .03), and longer LOS (8.4 vs 6.4; P = .05) compared with those without CT-CED. A vascular occlusion in the territory of the infarct was seen in 58% of patients with CT-CED versus 32% without CT-CED (P < .01). Atrial fibrillation (AF) was diagnosed in 61% patients with CT-CED versus 22% without (P < .01).

CONCLUSION

The CT-CED is associated with higher initial NIHSS, large vessel occlusion, and AF. Prospective studies are needed to ascertain whether CT-CED may be utilized part of a screen for endovascular therapy.

Micro-computed tomography analysis of post space preparation in root canals filled with carrier-based thermoplasticized gutta-percha

AIM

To determine whether post space preparation deviated from the root canal preparation in canals filled with Thermafil, GuttaCore or warm vertically compacted gutta-percha.

METHODOLOGY

Forty-two extracted human permanent maxillary lateral incisors were decoronated, and their root canals instrumented using a standardized protocol. Samples were divided into three groups and filled with Thermafil (Dentsply Tulsa Dental Specialties, Johnson City, TN, USA), GuttaCore (Dentsply Tulsa Dental Specialties) or warm vertically compacted gutta-percha, before post space preparation was performed with a GT Post drill (Dentsply Tulsa Dental Specialties). Teeth were scanned using micro-computed tomography after root filling and again after post space preparation. Scans were examined for number of samples with post space deviation, linear deviation of post space preparation and minimum root thickness before and after post space preparation. Parametric data were analysed with one-way analysis of variance (anova) or one-tailed paired Student's t-tests, whilst nonparametric data were analysed with Fisher's exact test.

RESULTS

Deviation occurred in eight of forty-two teeth (19%), seven of fourteen from the Thermafil group (50%), one of fourteen from the GuttaCore group (7%), and none from the gutta-percha group. Deviation occurred significantly more often in the Thermafil group than in each of the other two groups (P < 0.05). Linear deviation of post space preparation was greater in the Thermafil group than in both of the other groups and was significantly greater than that of the gutta-percha group (P < 0.05). Minimum root thickness before post space preparation was significantly greater than it was after post space preparation for all groups (P < 0.01).

CONCLUSIONS

The differences between the Thermafil, GuttaCore and gutta-percha groups in the number of samples with post space deviation and in linear deviation of post space preparation were associated with the presence or absence of a carrier as well as the different carrier materials.

Evaluation of nasal mucociliary transport rate according to nasal septum deviation type

BACKGROUND

Nasal septum deviation (NSD) may affect mucociliary activity (MCA) to varying degrees, depending upon the severity of the deviation. We used rhinoscintigraphy to determine the impact of the various NSD types on MCA.

METHODS

A recent classification describing 6 different forms of NSD was used to standardize the study. Forty-eight subjects were enrolled. Eight patients for each form of NSD were accrued for further study. Rhinoscintigraphy was performed using technetium 99m macroaggregated albumin ((99m) Tc-MAA) before and 3 months after surgery. Nasal mucociliary transport rate (NMTR), the half-time of (99m) Tc-MAA activity, and clearance rate over a 20-minute period were compared between groups.

RESULTS

Preoperative NMTR and clearance rates were significantly lower and half-time was significantly longer in types 4 and 6 than in the other groups. Although the postoperative NMTR and clearance rates increased compared with preoperative values in all groups, the increase was significant only in types 2, 4, and 6. The postoperative half-time increased significantly compared with the preoperative values in types 2, 4, and 6. The postoperative rhinoscintigraphy evaluation revealed no significant differences among groups in NMTR, half-time, or clearance rate.

CONCLUSION

NSD types 4 and 6 had lower preoperative NMTR and clearance rates and a longer half-time compared with the other groups. However, the postoperative values of these parameters were not significantly different among groups. Our results indicate that NSD types 4 and 6 had the greatest impact on MCA, suggesting that these patients may receive the maximum benefit from septoplasty.

Effects of deviation from focal plane on lesion geometry for ablative fractional photothermolysis

BACKGROUND AND OBJECTIVE

Fractional Photothermolysis (FP) is a method of skin treatment that generates a thermal damage pattern consisting of multiple columns of thermal damage, also known as microscopic treatment zones (MTZs). They are very small in diameter and are generated by application of highly focused laser beams. In order to obtain the smallest spot size, the treatment should be performed in the focal plane. Any deviation from the focal plane (DFP) results in an increase of spot size. FP devices typically utilize distance holders in order to facilitate exposures at this specific location. In spite of the use of distance holders, DFP can occur. In particular, variations of contact pressure to the skin surface and anatomical treatment areas of high surface curvature may be prone to DFP during FP treatments. The impact of such distance variation on lesion geometry, such as depth and diameter of the thermal injury, has not previously been evaluated. The objective of this study was to investigate the relation between DFP and the resulting lesion geometry for a selected ablative fractional device.

MATERIAL AND METHODS

A handpiece of an ablative fractional laser (DeepFX, UltraPulse Encore, Lumenis, Yokneam, Israel) was mounted to a rigid stand. Full thickness human skin obtained from abdominoplasty was mounted to a separate stand perpendicular to the handpiece. The tissue stand allowed the distance between the handpiece and the tissue to be adjusted to produce a variation up to ±3 mm from the focal plane. A 1 × 1 cm(2) scanning area of 169 MTZs, 50 mJ energy per MTZ, 120 μm nominal spot size, was applied at -3, -2, -1, 0, +1, +2, and +3 mm deviated from the focal plane. Minus (-) and plus (+) signs indicate decreasing and increasing distance between the handpiece and the tissue, respectively. Depth and diameter of the laser induced tissue lesions were assessed and quantified.

RESULTS

DFPs produced a significant alteration of the lesion geometry. DFPs of -3, -2, -1, 0, +1, +2, +3 mm resulted in average lesion depths of 1,020 (-40%), 1,180 (-31%), 1,400 (-18%), 1,700 (0%), 1,620 (-5%), 780 (-55%), 680 (-60%) µm, and average lesion diameters of 314 (+26%), 311 (+25%), 273 (+10%), 248 (0%), 256 (+3%), 316 (+27%), 359 (+44%) µm, respectively. The underlined values represent the focal plane. The percentage changes relative to values at focal plane are in parentheses.

CONCLUSIONS

A relatively minor DFP has a marked impact on the thermal injury profile, including lesion depth and diameter, of the laser-exposed tissue. Such marked changes of the thermal injury profile might affect the wound healing, safety, and efficacy of ablative fractional resurfacing procedures. Clinicians should carefully maintain the focal plane during ablative fractional treatment for reproducible results. The presented data are device specific and the clinical impact of such alteration of thermal injury profile warrants further investigation. Lasers Surg. Med. 48:555-561, 2016. © 2016 Wiley Periodicals, Inc.